Ultrasound of the nerves of the upper extremities at the Admiralty Shipyards. How is ultrasound diagnostics of the nerves of the upper extremities and the study of peripheral innervation done? What can be seen on an ultrasound of the peripheral nervous system

For the diagnosis of peripheral pathologies nerve structures The “gold standard” remains electrophysiological methods, which include neuromyography and electromyography. However, ultrasound of the nerves remains popular, since the listed methods have a number of disadvantages:

• do not provide the opportunity to assess the condition of adjacent tissues;
• will not indicate the cause of damage to the nerve structures;
• not informative in determining the nature of damage;
• do not accurately reflect the location of pathological processes.

But this is the information without which it is impossible to competently plan tactics, both operational and conservative treatment. More recently, diagnosis of the condition peripheral nerves was incomplete and lacked accuracy. However, the introduction of ultrasound examination of nerve structures into clinical practice has successfully filled the existing gaps.

At first pathological process, occurring in the peripheral nervous system, research is not always effective.

Reference! Some disorders do not reveal themselves for a long time and appear only during examination medical equipment high precision.

Other pathologies, for example, lumbago in the elbow or sciatic nerve, the patient rarely takes it seriously until the pain becomes unbearable and regular.

What symptoms are determining for a doctor who prescribes an ultrasound of peripheral nerves? There is a whole list of them:

• feeling of numbness in the limbs, disruption of their function;
• shooting pains;
• detected neoplasms in the projection of the trunks;
• foot paresis;
• burning sensation;
• any injuries that negatively affect the sensitivity of individual parts of the body or general motor activity;
• for visual assessment of the degree of dissection of the suspensory ligament of the carpal tunnel, if there is no improvement for a long time after decompression surgery;
• with benign fibrous tissue growths, for example, with Morton's neuroma;
• experiencing any extremely traumatic situations, including accidents;
• suspicion of tumors of any etiology.

What are they watching?

Ultrasound examination allows you to examine in detail peripheral structures, and, first of all, key nerves upper limbs:

• trunk and fibers radial nerve;
• median and brachial nerve bundles;
• carpal, musculocutaneous and axillary nerves;
• finger flexors.

In addition, with great difficulty, one can obtain information about nerves lower limbs. For example, determine the structure and localization of the following nerve endings:

• ischial and femoral;
• lower and upper gluteal;
• obturator and genital;
• iliogastric and inguinal;
• greater and fibula;
• plantar and medial cutaneous nerve feet.

Reference! Difficulty in examining individual nerve structures (eg, femoral, sacral, and lumbar nerves) consists in their deep occurrence.

These groups of nerves are deepened into soft tissues and hidden by bone elements. Therefore, an ultrasound sensor cannot always provide high-quality visualization.

Preparation

In preparation for peripheral sonography nervous system There are no specific preparatory measures. However, before the procedure, you should discuss your symptoms in detail with your doctor. .

Important! Based on the patient's complaints, the doctor may prescribe additional examinations, including laboratory tests, for example, neurological tests or tests.

If there are skin lesions at the site of the proposed examination, the procedure should be postponed until they are completely healed.

How do they do it?

In order to obtain a clear and accurate image, the sonologist applies a gel to the skin that enhances the conductivity of the sensor. To examine the sciatic nerve, the doctor sets the frequency to 3-5 MHz. For the radial, ulnar plexuses and other peripheral nerve structures, the frequency changes and becomes equal to 7 - 15 MHz.

Ultrasound of peripheral nerve fibers takes place in several stages:

1. First, the exact location of the object under study is determined.
2. Secondly, the desired nerve is examined in the transverse and longitudinal planes. Moreover, the assessment of large nerve trunks much simpler than searching and inspecting small branches. The fact is that during motor functional tests, small nerves may not be visible to the doctor.

Decoding

During the examination, the condition is determined nerve trunk, its integrity and structure, the condition of adjacent tissues and clarity of contours.

All these parameters must be reflected in the study protocol.

If negative changes are detected in the structure of nerve fibers, the doctor indicates:

• what type of damage;
• compression zone and its degree;
• cause of stenosis and reduction in nerve diameter.

If a neoplasm is found, the doctor supplements the protocol with its description, which indicates the contours, structure, blood flow (or lack thereof), and interaction with adjacent tissues.

It is better to start the examination peripheral endings from the point of greatest identification of the nerve trunk. Then, moving in the near and far directions, assess the condition and functional features nerve along its entire length.

Characteristic signs of nerves

There are a few characteristic features, which distinguish the image of a nerve from images of others anatomical structures:

1. The transverse projection presents the nerve as a round or oval structure with a smooth contour, increased echogenicity and a heterogeneous internal component.
2. The longitudinal projection demonstrates it as a linear formation with a smooth echogenic contour and regular alternation of stripes of different echogenicity. The thickness of the peripheral nerve structures can vary from 1 to 8 mm.

Inspection healthy nerve allows you to see a homogeneous formation with high echogenicity. Therefore, normal nerve tissue is not clearly visible on ultrasound. And here pathological changes in the nerves are accompanied by a decrease in echogenicity and thickening of the trunk. As a result, the changed area is identified by measuring basic parameters and detailed examination of the fibers.

Also dynamic tests are evaluated– studies of nerves under load. Such procedures are often performed in conjunction with Doppler studies of blood flow in the area under study.

This is necessary to obtain a detailed picture of the work of the nerves and the participation of blood vessels in this work.

During these tests, movements should be unimpeded and free.

This is necessary so that if certain pathologies are detected, it does not cause pinched nerves (for example, with osteophyte).

Determining the location of compression

One of the tasks of ultrasound of peripheral nerves is to determine the location of nerve compression. To do this, several basic parameters are used:

1. The degree of thickening in the place where compression is recorded. This parameter is calculated by dividing the maximum width of the nerve by its thickness. Normal value equal to 3.3 - everything that exceeds this indicator is considered pathological.
2. The area of ​​the site with increased thickness. If it exceeds the accepted standard value, then this also indicates a pathological process.
3. Reduced echogenicity and fibrousness of the nervous structure.
4. Changes in the structure of the nerve, an increase in the thickness of its individual bundles.

Pathologies

During an ultrasound examination, the doctor examines the structure of the nerve bundles and can detect deviations from the norm, which may be a sign of a pathological process. For example:

1. Inflammation– Ultrasound can reveal inflamed areas of nerves that cause pain, numbness, decreased sensitivity and other unpleasant symptoms.
2. Nerve injuries– when dislocated or sprained, there is a risk of injuring the fibers. You can find out about the presence of an injury of this kind only with an ultrasound examination of the problem area.
3. Post-traumatic conditions– diagnosed during the treatment of injury associated with a bone fracture. Often a fracture is accompanied by a rupture (stretch) of the nerve. If we are talking about a rupture, then neuromas appear at the ends of the torn fiber - thickenings formed due to cell regeneration. Changes in the nerve structure may also appear due to the cutting of fibers during cut wounds or pinched nerves during a fracture.
4. Pinching– unsuccessful movements, diseases of the musculoskeletal system or injuries of any kind can cause the formation of a compression area. Over time, the bone tissue in such an area is deformed, which is fraught with the formation of osteophytes - pathological growths on bone tissue. Pinching can also occur due to the development of a tumor - soft tissues can pinch the nerve structure.
5. Tumors of various etiologies – predominantly affect the sheath of the nerve bundle, in this case they speak of the formation of a schwannoma or neurofibroma.
6. Morton's neuroma– characterized by thickening of the interdigital endings due to the activity of the tumor process.
7. Compression of nerve fibers– the cause is often the placement of abnormally located vessels and muscles in the tunnels. It manifests itself as severe deformation of the nerve, the development of neuromas, and atrophy of altered fibers. On an ultrasound, the doctor observes thickening of the nerve structure and the development of carpal tunnel syndrome.
8. Tunnel type neuropathy– it is characterized by compression of nerve endings by tendons and bones. Typically found in people whose work involves computers.
9. Diseases that cause pathologies of the nervous system. This includes a wide group of pathologies, from cysts and hematomas to injuries and thrombosis. Provocateurs are any conditions that can lead to compression of peripheral endings.

For any pathology of the peripheral nerves, it will be prescribed additional examination, to clarify the final diagnosis. In addition to ultrasound, Doppler scanning and neuromyelography are often used.

Conducting functional tests is an important part of diagnosing neural structures.

For example, they make it possible to analyze the displacement of the sciatic nerve and surrounding tissues.

Based on similar tests, dislocation of the sciatic nerve is determined.

It is important to understand that this nerve can be constantly injured by nearby bones.

Contraindications

No contraindications were found for ultrasound of peripheral nerves.

pros

Ultrasound of peripheral nervous structures is a diagnostic method that is widely in demand in modern medical institutions. This method of examination has a number of positive aspects:

• financial inclusion;
• no radiation exposure;
• safety for all categories of patients;
• absence of contraindications and preparatory measures;
• the possibility of dynamic assessment of the condition of the problem area;
• opportunity complex diagnostics in combination with other examination methods;
• good visualization of nerve fibers and endings;
• the ability to conduct examinations as many times as necessary and as often as the patient needs.

Minuses

Despite the fact that the diagnostic method of ultrasound has a lot of advantages, it is not without its disadvantages.

Undesirable aspects of ultrasound examination include insufficient passage of nerve impulses with an inconvenient location of the nerve for examination.

Therefore, it is not always possible to qualitatively examine the area of ​​the peripheral nervous system that interests the doctor.

Thus, examination of the radial nerve trunk will be much more informative than examination of the tibial trunk. Inspection may be difficult:

• heavy weight of the patient;
• deep location of the nerve;
• the location of the bone structures covering the object of study.

Besides Ultrasound is a rather subjective method and this is its main drawback. The interpretation of the data obtained depends too much on the experience and qualifications of the personnel, as well as on the quality of the equipment.

Price and where to make it?

Pass the ultrasound examination peripheral nerves can be done at any budget clinic in the city. In addition, high-quality, but paid medical services can be obtained from private clinics. The price of an ultrasound scan in Moscow of nerve endings can vary from 900 to 1500 rubles.

Conclusion

IN clinical practice Ultrasound examinations of individual organs and systems are becoming increasingly important and in demand. Sonography has undeniable advantages over others diagnostic methods. Mainly, they consist in the safety, low cost and informativeness of the procedure.

To date this procedure is included in the list of mandatory manipulations that are performed if compression or damage to one of the nerve trunks is suspected.

Previous techniques for studying the peripheral nervous system, such as electromyography, provide information only about functional activity nerve trunk, which is not enough to resolve the issue of effective treatment diseases of the nerve endings. Ultrasound of the nerves makes it possible to study their anatomy, which is an undeniable advantage of this diagnostic procedure.

Peripheral nerves studied

The separation ability of even the most modern ultrasound devices allows for an informative examination of only medium and large nerve trunks. Among the nerves that are subject to ultrasound diagnostics, you need to highlight:

• Ulnar nerve.
• Radial nerve.
• Median nerve.
• Common peroneal nerve.
• Common tibial nerve.
• Sciatic nerve.

Ultrasound examination of all other peripheral nerves can be informative only in the case of a pronounced pathological process.

Parameters determined by ultrasound of nerves

To make a conclusion about the condition of the nerve trunk, during its ultrasound examination the following parameters are assessed:

• Thickness of the nerve trunk.
• Cross section shape.
• Contours of the nerve in longitudinal and transverse sections.
• Nerve fiber structure.
• Availability pathological formations.

Besides, most Ultrasound examination of nerves involves a comparative analysis of their indicators at different segments. This makes it possible to identify pathological changes with maximum consideration individual characteristics each person.

Indications for ultrasound of nerves

Ultrasound examination has no restrictions or contraindications. That is why it can be prescribed to absolutely all patients who have symptoms indicating nerve damage:

• Pain in the projection of the nerve trunks, which, as a rule, has the character of lumbago.
• Impaired sensitivity in the area of ​​innervation of certain nerves.
• Paresthesia: tingling, tingling, crawling sensation in the upper or lower extremities.
• Violation motor activity in one of the body parts.
• Palpation of pathological formations in the projection of large nerves.
• Traumatic injuries bodies in the place of nerve trunks.

Preparation and methodology

Ultrasound examination of the peripheral nervous system is carried out without special preliminary preparation. The procedure is usually performed while the patient is in hospital. supine position bodies. To visualize certain anatomical structures, the patient may be asked to change the position of the limb.

Diseases diagnosed during nerve ultrasound

Ultrasound examination of the peripheral nervous system allows us to draw a conclusion about possible availability one of the following diseases or pathological conditions:

• Neoplasms of nerve fibers. In clinical practice, there are two types of nerve tumors, neurofibroma and schwannoma, which can be distinguished by ultrasound. The first comes from the central part of the nerve, and the second from its sheaths.
• Acute and chronic injuries of nerve trunks: sprains, tears, ruptures.
• Compression of the nerve by adjacent muscle or bone structures. The so-called tunnel syndrome.
• Morton's neuroma is a false tumor that is a growth of nerves in the spaces between the fingers.
• Neuritis is inflammation of the nerves of various origins.

Doctors examine peripheral nerves using ultrasound when a patient complains of severe pain, loss of sensation or numbness.

• Pinching. A procedure is prescribed if the formation of a compression area is suspected. It is by performing an ultrasound that specialists can quickly detect where the nerve is pinched.
• Tunnel neuropathy. Ultrasound of the radial nerve is prescribed to identify this condition. This problem is often observed among people who work at a computer.
• Inflammatory diseases. The appearance of pain in the patient's radial, sciatic or ulnar nerve becomes the basis for an urgent ultrasound appointment. The study helps detect inflammation and assess its prevalence.
• Tumor neoplasms. Examination of peripheral nerves using ultrasound can reveal lesions of the nerve bundle sheath. The method allows doctors to quickly diagnose neurofibroma.
• Compression of nerves. The symptoms experienced by the patient may be caused by cysts, aneurysms, or tumors. They put pressure on the nerves, causing pain. And on ultrasound, doctors will find diseases that provoke neurological problems.

Price for ultrasound of peripheral nerves

The cost of research at the Open Clinic will pleasantly surprise you. We often offer discounts on diagnostics, so check the prices for ultrasound by calling the numbers provided.

Examination in our centers in Moscow

You can undergo an ultrasound scan of peripheral nerves in any department of our clinic. Therefore, find the center closest to you " Open Clinic", operating in Moscow, and sign up for an examination now.

Research cost: -joints (for one joint) - doctor - 3500 rubles, professor - 6000 rubles - nerves (for one nerve) - doctor - 3500 rubles, professor - 6000 rubles

Brief information. Nerves are bundles of nerve fibers (processes nerve cells), through which nerve impulses are carried from the center to the periphery and vice versa. Nerves can suffer as a result of injury, external compression, tumor growth, and sometimes they are affected due to lack of blood supply. Among all the causes, vertebrogenic lesions of the roots are leading spinal cord. Often there are primary processes that lead to disturbances in nerve conduction, in particular those of inflammatory origin.

Joints provide mobility to various segments of the body and limbs and overall mobility of a person by connecting bones to each other. Joints are quite complex: the contacting surfaces of the bones are covered with cartilage, and between them there is renewable joint fluid. The framework of the joints and the direction of movement in them are supported by numerous ligaments. Over time separate structures(primarily cartilage) undergo degenerative changes and can ossify (osteoarthrosis). In addition, there are numerous inflammatory diseases joints - arthritis. Articular syndrome is part of a syndrome complex of various general somatic diseases, for example, systemic rheumatoid diseases. Pathological changes associated with injuries are common. Other diseases, including neoplastic ones, also occur.

The ligamentous apparatus helps maintain position, as well as provide directed movements (stabilization of joints, etc.). Ligaments can suffer due to inflammatory changes, injuries and other causes (tumors, etc.).

The role of ultrasound in the diagnosis of diseases of peripheral nerves, joints, and ligaments.

Ultrasound examination is the method of choice, as well as an auxiliary technique for certain types of lesions of joints, ligaments and peripheral nerves. Despite the enthusiasm for these studies in last years, their resolution is not enough in many diagnostic situations.

Titles of studies: Ultrasound examination (US), duplex scanning (DS) of joints, ligaments, peripheral nerves.

Scope of research*:

Ultrasound examination of the joint:

• two-dimensional gray scale echography of the joint and ligaments
• duplex scanning of the joint and ligaments

Ultrasound examination of the peripheral nerve:

• two-dimensional greyscale echography of the peripheral nerve
• duplex scanning of the peripheral nerve

________________

* In the Multidisciplinary Professorial medical center « Vascular clinic At Patriarch's, isolated ultrasound examinations in mono modes are not practiced. In the interests of the patient, Doppler scanning modes are used for all types of studies.

Purpose of the study:

For the joint and ligaments:

• determining the condition of the articular surface, assessing the amount and nature of the joint fluid, determining the presence and properties of additional formations, studying the echographic characteristics of the soft tissues surrounding the joint
• in the presence of additional formations - determination of their size, shape, location, structure, as well as the nature of the distribution of color cartograms of flows and linear characteristics blood flow in their vessels

For peripheral nerves:

• study of the contour, diameter, structure, continuity, echogenicity of the nerve, the state of the surrounding tissues, in the presence of additional formations - their properties, as well as the nature of the distribution of color cartograms of flows and linear characteristics of blood flow in their vessels

Indications for ultrasound (US) of peripheral nerves, joints, ligaments:

The most common conditions and diseases of the joints for which ultrasound examination is performed:

• exclusion (confirmation) of dysplasia hip joint in children (up to 3 - 4 months)
• joint pain
• restrictions on joint movement
• joint deformity
• swelling of the joints
• additional education
• joint injury

The most common conditions and diseases of the nerves for which it is performedultrasonography:

• nerve injury
• suspected nerve compression
• the need to exclude a tumor
• nerve inflammation

Preparing for the study.

Ultrasound of joints, ligaments and nerves using modern diagnostic equipment, available in our center “Vascular Clinic on Patriarch’s”, in most cases does not require special training.

Ultrasound modes and technologies used when conducting ultrasound examination of peripheral nerves, joints and ligaments at the Vascular Clinic on Patriarch's Center:

• two-dimensional gray scale echography (B-mode);
• color Doppler coding - by speed, intensity or energy, convergent or directed energy (CD - mode);
• spectral Doppler analysis (PW - mode);
• duplex scanning;
• triplex duplex scanning mode - triplex scanning.

Based on the research results, the following are issued:

• conclusion (hard copy) - included in the base price
• conclusion in in electronic format (additional service)
• Images ultrasound examinations- static black and white (hard copy), printed on a video printer (additional service)
• ultrasound images - static color (hard copy) (additional service),
• ultrasound images- static or dynamic on the client’s magnetic media (additional service),
• on magnetic media provided by the center (additional service)

Using modern high-frequency matrix and broadband sensors, it is possible to process the ultrasonic signal. Thanks to ultrasound of the nerves, you can examine the condition of your peripheral nerves. For example, a specialist will examine your tailbone or other area at a time convenient for you.

In what cases is an examination prescribed?

Not all patients are conscientious and go to the doctor at the first sign of illness. Many people ignore pain in the elbow. Only an ultrasound of the sciatic nerve shows problems in this area. When the pain becomes constant and severe, the patient urgently needs an ultrasound scan and comes in for examination.

Peripheral nerves need to be examined if you feel:

• Painful lumbago;
• Your limbs go numb;
• You feel a burning sensation;
• Your arms and legs don't obey you as much as they used to;
• Your foot is now “slapping.” This is such a syndrome;
• You were injured at home or in an accident, you were deeply cut due to which parts of your body lost sensitivity;
• The doctor suspects you have a tumor (no matter what type), for example, near the tailbone or elsewhere, a neuroma.

Main characteristics of the survey

The doctor, watching the ultrasound examination on the screen, will see where your problem areas are and what the deviations from the norm are. With ultrasound, the following indicators are considered basic:

• There are changes in the structure;
• The echogenicity of the trunk becomes less or increases, the fibers are heterogeneous in density and are abnormally highlighted;
• How flattened the nerve is. The trunk is pre-measured to determine its thickness and width. The largest width is divided by the thickness index. You will receive the coefficient. So, you will find out how much it flattens if you click on it certain place. A cross section is made and compared with the standards for a specific area.

"Advice. If, after such a detailed examination, a pathology is discovered, the doctor will know how to optimally treat it and will prescribe medications for you.”

The examination will show where there is inflammation of the nerve tissue (for example, in the buttock), a neoplasm or abnormal vascularity or a break in the fibers. You will get rid of your illness faster than if you were treated according to general symptoms at random. The doctor will find out where it is pinched and select treatment.

Preparation and methodology

No special preparation is required for ultrasound of nervous tissue. If you have wounds or irritations on your skin, postpone the examination for a while. The doctor will schedule a re-examination for you later.

At stage 1, the doctor will find your nerves. Large trunks are much more noticeable than small ones. The doctor will perform texts during which you will move your limbs. You will be tested to determine your symptoms.

To make the examination easy and pleasant, a gel will be applied to your skin. A sensor with a frequency of 3 to 5 MHz will be moved to the locations of the nerves. The ischium is examined at a frequency of 7 to 15 MHz. First, a topographic search is carried out and scanning is carried out. If there are problems, it is clear why pain occurs in the coccyx area.

If you need to find the medial one, then it is located at the wrist, in the area of ​​the palm tendon. If the specialist stops seeing it on the screen, he can return to the starting point and continue the examination. The doctor makes a transverse section, examines it enlarged, and then makes the image larger and examines the longitudinal one.

Nerves that can be seen with the machine

An ultrasound of the peripheral nerves will show their structure in the patient’s hands:

• Located on the shoulder;
• Ray. What is the condition of its fibers?
• Located under the arms;
• Median;
• Muscular with skin;
• Elbow. Its trunk;
• Located in the wrist area;
• The fingers have flexors.

An ultrasound will also show the condition of the nerves in the legs, specifically the trunks with branches:

• Sciatica (pain in the coccyx area);
• Passing in the gluteal region (bottom and top);
• Located in the thigh;
• Passing through the genitals;
• Obturator;
• Ileum with hypogastric;
• Ileum with inguinal;
• Malonetsovy;
• Bolshebtsovogo;
• Located on the sole;
• On the skin of the foot (medial).

The nerves in the lower back with the sacrum and on the hips are deep in the tissues. Access to them is difficult and ultrasound cannot always clearly show what condition they are in.

"Advice. Then you can undergo additional examination in other ways: Doppler mapping, neuromyelography.”

Norms

Ultrasound ulnar nerve with radiation and any others, if they are not affected by the disease, their fibers will be perfectly shown. They will look dense. If there is pathology, then the trunks become thicker and the nervous tissue less dense. The specialist will locate the affected area.

It is important that a person can move his arms and legs freely without experiencing pain. If the patient has something that hurts, it may be inflammation or pinching. With an osteophyte that blocks normal functionality, a person feels discomfort, and with ultrasound, the nerve appears to be pinched.

A specialist, conducting an ultrasound examination, will evaluate the thickness and width of the trunks and branches of the nerves. If you take the ratio of width to thickness, the doctor will determine a coefficient that will show that the trunk and its branches are flattened. If it comes out 3.3, then this is the norm. The above indicators indicate pathological processes.

"Advice. Immediately after diagnosis, begin treatment for inflammation and other pathologies.”

Problems that can be diagnosed

When studies are carried out using ultrasound, the following pathologies can be seen:

• The nerve becomes inflamed. The device will show exactly where the abscess is occurring. The patient feels: pain with numbness, low sensitivity and other symptoms. Many people have problems with those located in the wrist area or with the elbow, sciatic. There is pain in the coccyx area or disturbances in the area median nerve or ultrasound of the radial nerve is required;
• Pinching most often occurs in the ridge. Especially if you are injured or bend over unsuccessfully, etc. A compression area is formed. Bone tissue becomes deformed and osteophytes develop, which aggravates the patient’s condition. It may get pinched and soft tissues when a tumor develops;
• Neoplasms most often affect the sheath of the nerve bundle. An ultrasound will show a schwannoma with a neurofibroma;
• Injury to an arm or leg, both. When you have a dislocation or fracture, the nerve fibers are often stretched or torn.
• Morton's neuroma. The tumor is growing and nerve endings thicken between the fingers.
• In the nervous system. These could be: a hematoma with a cyst, a tumor with a fracture, many inflammatory formations with osteophytes, aneurysms and thromboses, and other pathologies. They arise due to compression.
• Tunnel neuropathy. It may occur due to the fact that tendons with bones compress the nervous tissue. Those who do a lot of typing at the computer often suffer from carpal tunnel syndrome.

Nerve ultrasound is available and safe procedure. Can be combined with Doppler mapping and neuromyelography. If you have an abscess or a pinched nerve, consult a doctor and get an ultrasound. A trained specialist will find the affected area, for example, around the wrist, and your doctor will prescribe treatment.